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Lee WE, Besnier M, Genetzakis E, Tang O, Kott KA, Vernon ST, Gray MP, Grieve SM, Kassiou M, Figtree GA. High-Throughput Measure of Mitochondrial Superoxide Levels as a Marker of Coronary Artery Disease to Accelerate Drug Translation in Patient-Derived Endothelial Cells Using Opera Phenix ® Technology. Int J Mol Sci 2023; 25:22. [PMID: 38203193 PMCID: PMC10779289 DOI: 10.3390/ijms25010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
Improved human-relevant preclinical models of coronary artery disease (CAD) are needed to improve translational research and drug discovery. Mitochondrial dysfunction and associated oxidative stress contribute to endothelial dysfunction and are a significant factor in the development and progression of CAD. Endothelial colony-forming cells (ECFCs) can be derived from peripheral blood mononuclear cells (PBMCs) and offer a unique potentially personalised means for investigating new potential therapies targeting important components of vascular function. We describe the application of the high-throughput and confocal Opera Phenix® High-Content Screening System to examine mitochondrial superoxide (mROS) levels, mitochondrial membrane potential, and mitochondrial area in both established cell lines and patient-derived ECFCs simultaneously. Unlike traditional plate readers, the Opera Phenix® is an imaging system that integrates automated confocal microscopy, precise fluorescent detection, and multi-parameter algorithms to visualize and precisely quantify targeted biological processes at a cellular level. In this study, we measured mROS production in human umbilical vein endothelial cells (HUVECs) and patient-derived ECFCs using the mROS production probe, MitoSOXTM Red. HUVECs exposed to oxidized low-density lipoprotein (oxLDL) increased mROS levels by 47.7% (p < 0.0001). A pooled group of patient-derived ECFCs from participants with CAD (n = 14) exhibited 30.9% higher mROS levels compared to patients with no CAD when stimulated with oxLDL (n = 14; p < 0.05). When tested against a small group of candidate compounds, this signal was attenuated by PKT-100 (36.22% reduction, p = 0.03), a novel P2X7 receptor antagonist. This suggests the P2X7 receptor as a valid target against excess mROS levels. As such, these findings highlight the potential of the MitoSOX-Opera Phenix technique to be used for drug discovery efforts in CAD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gemma A. Figtree
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia (M.K.)
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Chan AS, Wu S, Vernon ST, Tang O, Figtree GA, Liu T, Yang JY, Patrick E. Overcoming cohort heterogeneity for the prediction of subclinical cardiovascular disease risk. iScience 2023; 26:106633. [PMID: 37192969 PMCID: PMC10182278 DOI: 10.1016/j.isci.2023.106633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/03/2023] [Accepted: 04/04/2023] [Indexed: 05/18/2023] Open
Abstract
Cardiovascular disease remains a leading cause of mortality with an estimated half a billion people affected in 2019. However, detecting signals between specific pathophysiology and coronary plaque phenotypes using complex multi-omic discovery datasets remains challenging due to the diversity of individuals and their risk factors. Given the complex cohort heterogeneity present in those with coronary artery disease (CAD), we illustrate several different methods, both knowledge-guided and data-driven approaches, for identifying subcohorts of individuals with subclinical CAD and distinct metabolomic signatures. We then demonstrate that utilizing these subcohorts can improve the prediction of subclinical CAD and can facilitate the discovery of novel biomarkers of subclinical disease. Analyses acknowledging cohort heterogeneity through identifying and utilizing these subcohorts may be able to advance our understanding of CVD and provide more effective preventative treatments to reduce the burden of this disease in individuals and in society as a whole.
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Affiliation(s)
- Adam S. Chan
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Precision Data Science Centre, The University of Sydney, Sydney, NSW, Australia
| | - Songhua Wu
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Stephen T. Vernon
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Owen Tang
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Gemma A. Figtree
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tongliang Liu
- Sydney Precision Data Science Centre, The University of Sydney, Sydney, NSW, Australia
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Jean Y.H. Yang
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Precision Data Science Centre, The University of Sydney, Sydney, NSW, Australia
- Corresponding author
| | - Ellis Patrick
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
- Sydney Precision Data Science Centre, The University of Sydney, Sydney, NSW, Australia
- Westmead Medical Institute, Sydney, NSW, Australia
- Corresponding author
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3
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Treibel TA, Kelion A, Ingram TE, Archbold RA, Myerson SG, Menezes LJ, Morgan-Hughes GJ, Schofield R, Keenan NG, Clarke SC, Keys A, Keogh B, Masani N, Ray S, Westwood M, Pearce K, Colebourn CL, Bull RK, Greenwood JP, Roditi GH, Lloyd G. United Kingdom standards for non-invasive cardiac imaging: recommendations from the Imaging Council of the British Cardiovascular Society. Heart 2022; 108:e7. [PMID: 35613713 DOI: 10.1136/heartjnl-2022-320799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.
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Affiliation(s)
- Thomas A Treibel
- Cardiac Imaging, Saint Bartholomew's Hospital Barts Heart Centre, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Andrew Kelion
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Andrew Archbold
- General & Invasive Cardiology, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Saul G Myerson
- Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Leon J Menezes
- Department of Nuclear Cardiology, Barts Health NHS Trust, London, London, UK
| | | | - Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Niall G Keenan
- Department of Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Sarah C Clarke
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Bruce Keogh
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Navroz Masani
- Department of Cardiology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
| | - Simon Ray
- Cardiology, University Hospitals of South Manchester, Manchester, UK
| | - Mark Westwood
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Keith Pearce
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - John Pierre Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Giles H Roditi
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Guy Lloyd
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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4
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Vernon ST, Kott KA, Hansen T, Finemore M, Baumgart KW, Bhindi R, Yang J, Hansen PS, Nicholls SJ, Celermajer DS, Ward MR, van Nunen SA, Grieve SM, Figtree GA. Immunoglobulin E Sensitization to Mammalian Oligosaccharide Galactose-α-1,3 (α-Gal) Is Associated With Noncalcified Plaque, Obstructive Coronary Artery Disease, and ST-Segment-Elevated Myocardial Infarction. Arterioscler Thromb Vasc Biol 2022; 42:352-361. [PMID: 35045730 DOI: 10.1161/atvbaha.121.316878] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treating known risk factors for coronary artery disease (CAD) has substantially reduced CAD morbidity and mortality. However, a significant burden of CAD remains unexplained. Immunoglobulin E sensitization to mammalian oligosaccharide galactose-α-1,3-galactose (α-Gal) was recently associated with CAD in a small observational study. We sought to confirm that α-Gal sensitization is associated with CAD burden, in particular noncalcified plaque. Additionally, we sort to assess whether that α-Gal sensitization is associated with ST-segment-elevated myocardial infarction (STEMI) Methods: We performed a cross-sectional analysis of participants enrolled in the BioHEART cohort study. We measured α-Gal specific-immunoglobulin E antibodies in serum of 1056 patients referred for CT coronary angiography for suspected CAD and 100 selected patients presenting with STEMI, enriched for patients without standard modifiable risk factors. CT coronary angiograms were assessed using coronary artery calcium scores and segmental plaque scores. RESULTS α-Gal sensitization was associated with presence of noncalcified plaque (odds ratio, 1.62 [95% CI, 1.04-2.53], P=0.03) and obstructive CAD (odds ratio, 2.05 [95% CI, 1.29-3.25], P=0.002), independent of age, sex, and traditional risk factors. The α-Gal sensitization rate was 12.8-fold higher in patients with STEMI compared with matched healthy controls and 2.2-fold higher in the patients with STEMI compared with matched stable CAD patients (17% versus 1.3%, P=0.01 and 20% versus 9%, P=0.03, respectively). CONCLUSIONS α-Gal sensitization is independently associated with noncalcified plaque burden and obstructive CAD and occurs at higher frequency in patients with STEMI than those with stable or no CAD. These findings may have implications for individuals exposed to ticks, as well as public health policy. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12618001322224.
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Affiliation(s)
- Stephen T Vernon
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Katharine A Kott
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Thomas Hansen
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Meghan Finemore
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia
| | | | - Ravinay Bhindi
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Jean Yang
- Charles Perkins Centre (J.Y., S.M.G., G.A.F.) University of Sydney, Australia.,School of Mathematics and Statistics (J.Y.) University of Sydney, Australia
| | - Peter S Hansen
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Australia (S.J.N.)
| | - David S Celermajer
- Sydney Medical School (D.S.C.) University of Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (D.S.C.)
| | - Michael R Ward
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
| | - Sheryl A van Nunen
- Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Northern Beaches Hospital, Sydney, Australia (S.A.v.N.)
| | - Stuart M Grieve
- Charles Perkins Centre (J.Y., S.M.G., G.A.F.) University of Sydney, Australia.,Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health (S.M.G.), University of Sydney, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia (S.M.G.)
| | - Gemma A Figtree
- Cardiovascular Discovery Group, Kolling Institute of Medical Research (S.T.V., K.A.K., T.H., M.F., G.A.F.) University of Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health (S.T.V., K.A.K., T.H., M.F., R.B., P.S.H., M.R.W., S.A.v.N., G.A.F.) University of Sydney, Australia.,Charles Perkins Centre (J.Y., S.M.G., G.A.F.) University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia (S.T.V., K.A.K., T.H., R.B., P.S.H., M.R.W., G.A.F.)
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5
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Mander GT, Dobeli K, Steffensen C, Munn Z. Diagnostic accuracy of prospectively gated, 128-slice or greater CTCA at high heart rates: a systematic review and meta-analysis. J Med Radiat Sci 2021; 68:435-445. [PMID: 34235885 PMCID: PMC8656183 DOI: 10.1002/jmrs.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Prospectively gated 64-slice CT coronary angiography (CTCA) may be contraindicated for heart rates (HRs) over 65 beats per minute (bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically provide 128 or more slices and superior temporal resolution compared with older models; consequently, diagnostic accuracy for current technology prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of this systematic review was to investigate the diagnostic accuracy of CTCA using 128-slice or greater CT technology when compared with conventional coronary angiography for patients with HRs >65 bpm. METHODS A systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as well as unpublished databases, sources and reference lists. Titles and abstracts were screened by two independent reviewers. Full-text screening was then performed. Studies that determined diagnostic accuracy of coronary artery stenosis in adult patients with high heart rates utilising prospectively gated 128 detector or greater scanners were included. Studies that were included in the review underwent critical appraisal using the QUADAS-2 tool. RESULTS Ten studies were included in the systematic review, with nine of these included in a diagnostic test accuracy meta-analysis, including six of which reported data at the patient level. Meta-analysis indicated very high pooled sensitivity 100% (95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI 0.69, 0.88). CONCLUSIONS Prospectively gated CT coronary angiography may be justifiable at heart rates above 65 bpm if performed on a 128-slice or greater CT unit. Caution regarding the implication of a positive result is recommended due to reduced specificity. Further evidence is required before consideration of a new higher heart threshold.
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Affiliation(s)
- Gordon T.W. Mander
- Toowoomba HospitalDarling Downs HealthQueensland HealthToowoombaQueenslandAustralia
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Karen Dobeli
- Royal Brisbane and Women’s HospitalMetro North Hospital and Health ServiceQueensland HealthHerstonQueenslandAustralia
| | - Caitlin Steffensen
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Philips Australia and New ZealandBrisbaneQueenslandAustralia
| | - Zachary Munn
- Faculty of Health SciencesJoanna Briggs InstituteUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Zhang L, Li L, Feng G, Fan T, Jiang H, Wang Z. Advances in CT Techniques in Vascular Calcification. Front Cardiovasc Med 2021; 8:716822. [PMID: 34660718 PMCID: PMC8511450 DOI: 10.3389/fcvm.2021.716822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular calcification, a common pathological phenomenon in atherosclerosis, diabetes, hypertension, and other diseases, increases the incidence and mortality of cardiovascular diseases. Therefore, the prevention and detection of vascular calcification play an important role. At present, various techniques have been applied to the analysis of vascular calcification, but clinical examination mainly depends on non-invasive and invasive imaging methods to detect and quantify. Computed tomography (CT), as a commonly used clinical examination method, can analyze vascular calcification. In recent years, with the development of technology, in addition to traditional CT, some emerging types of CT, such as dual-energy CT and micro CT, have emerged for vascular imaging and providing anatomical information for calcification. This review focuses on the latest application of various CT techniques in vascular calcification.
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Affiliation(s)
- Lijie Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guoquan Feng
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Tingpan Fan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Han Jiang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Patient Endothelial Colony-Forming Cells to Model Coronary Artery Disease Susceptibility and Unravel the Role of Dysregulated Mitochondrial Redox Signalling. Antioxidants (Basel) 2021; 10:antiox10101547. [PMID: 34679682 PMCID: PMC8532880 DOI: 10.3390/antiox10101547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/02/2023] Open
Abstract
Mechanisms involved in the individual susceptibility to atherosclerotic coronary artery disease (CAD) beyond traditional risk factors are poorly understood. Here, we describe the utility of cultured patient-derived endothelial colony-forming cells (ECFCs) in examining novel mechanisms of CAD susceptibility, particularly the role of dysregulated redox signalling. ECFCs were selectively cultured from peripheral blood mononuclear cells from 828 patients from the BioHEART-CT cohort, each with corresponding demographic, clinical and CT coronary angiographic imaging data. Spontaneous growth occurred in 178 (21.5%) patients and was more common in patients with hypertension (OR 1.45 (95% CI 1.03-2.02), p = 0.031), and less likely in patients with obesity (OR 0.62 [95% CI 0.40-0.95], p = 0.027) or obstructive CAD (stenosis > 50%) (OR 0.60 [95% CI 0.38-0.95], p = 0.027). ECFCs from patients with CAD had higher mitochondrial production of superoxide (O2--MitoSOX assay). The latter was strongly correlated with the severity of CAD as measured by either coronary artery calcium score (R2 = 0.46; p = 0.0051) or Gensini Score (R2 = 0.67; p = 0.0002). Patient-derived ECFCs were successfully cultured in 3D culture pulsatile mini-vessels. Patient-derived ECFCs can provide a novel resource for discovering mechanisms of CAD disease susceptibility, particularly in relation to mitochondrial redox signalling.
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8
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Vernon ST, Kott KA, Hansen T, Zhang KJ, Cole BR, Coffey S, Grieve SM, Figtree GA. Coronary artery disease burden in women poorly explained by traditional risk factors: Sex disaggregated analyses from the BioHEART-CT study. Atherosclerosis 2021; 333:100-107. [PMID: 34045070 DOI: 10.1016/j.atherosclerosis.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Targeting the modifiable risk factors for coronary artery disease (CAD) has substantial impact at the community level. However, it is not uncommon for individuals to present with atherosclerosis related events without identified risk factors. We examined sex differences in the association of risk factors and atherosclerotic burden assessed by CT coronary angiography (CTCA). METHODS We analysed clinical and imaging data in 1002 individuals in the BioHEART cohort. RESULTS 45% were female, 35% had no CAD identified. Median coronary calcium score was 9.9 Agatston units (IQR: 0-146), and median Gensini Score was 3.5 (IQR: 0-11.5). 26% had a calcified plaque predominant phenotype, and 18% had a non-calcified plaque predominant phenotype. There were no sex differences in the prevalence of risk factors. However, there were notable sex differences in the adjusted associations of risk factors with CAD. Age and hypercholesterolaemia (OR 1.56, 95% CI 1.03-2.36, p = 0.04 in males, and OR 1.75, 95% CI 1.09-2.78, p = 0.02 in females) were associated with the presence of CAD in both genders (p < 0.05). Diabetes and smoking were associated with presence of CAD, calcified CAD, and non-calcified plaque in males (p < 0.05) but not females. In women, none of the standard modifiable risk factors were associated with the amount of plaque present when adjusted for age, BMI, and family history of premature CAD. CONCLUSIONS CTCA provides an important opportunity for improving the stratification of cohorts to assess underlying biology and risk. We demonstrate sex-specific differences in associations of risk factors with atherosclerosis burden.
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Affiliation(s)
- Stephen T Vernon
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Katharine A Kott
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Thomas Hansen
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Kimble J Zhang
- Faculty of Science, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Ben R Cole
- Cardiology Department, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Sean Coffey
- Dunedin School of Medicine University of Otago Dunedin New Zealand, New Zealand
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia; Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Gemma A Figtree
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, University of Sydney, Australia; Department of Cardiology, Royal North Shore Hospital, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia.
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9
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Vernon ST, Tang O, Kim T, Chan AS, Kott KA, Park J, Hansen T, Koay YC, Grieve SM, O’Sullivan JF, Yang JY, Figtree GA. Metabolic Signatures in Coronary Artery Disease: Results from the BioHEART-CT Study. Cells 2021; 10:980. [PMID: 33922315 PMCID: PMC8145337 DOI: 10.3390/cells10050980] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 01/06/2023] Open
Abstract
Despite effective prevention programs targeting cardiovascular risk factors, coronary artery disease (CAD) remains the leading cause of death. Novel biomarkers are needed for improved risk stratification and primary prevention. To assess for independent associations between plasma metabolites and specific CAD plaque phenotypes we performed liquid chromatography mass-spectrometry on plasma from 1002 patients in the BioHEART-CT study. Four metabolites were examined as candidate biomarkers. Dimethylguanidino valerate (DMGV) was associated with presence and amount of CAD (OR) 1.41 (95% Confidence Interval [CI] 1.12-1.79, p = 0.004), calcified plaque, and obstructive CAD (p < 0.05 for both). The association with amount of plaque remained after adjustment for traditional risk factors, ß-coefficient 0.17 (95% CI 0.02-0.32, p = 0.026). Glutamate was associated with the presence of non-calcified plaque, OR 1.48 (95% CI 1.09-2.01, p = 0.011). Phenylalanine was associated with amount of CAD, ß-coefficient 0.33 (95% CI 0.04-0.62, p = 0.025), amount of calcified plaque, (ß-coefficient 0.88, 95% CI 0.23-1.53, p = 0.008), and obstructive CAD, OR 1.84 (95% CI 1.01-3.31, p = 0.046). Trimethylamine N-oxide was negatively associated non-calcified plaque OR 0.72 (95% CI 0.53-0.97, p = 0.029) and the association remained when adjusted for traditional risk factors. In targeted metabolomic analyses including 53 known metabolites and controlling for a 5% false discovery rate, DMGV was strongly associated with the presence of calcified plaque, OR 1.59 (95% CI 1.26-2.01, p = 0.006), obstructive CAD, OR 2.33 (95% CI 1.59-3.43, p = 0.0009), and amount of CAD, ß-coefficient 0.3 (95% CI 0.14-0.45, p = 0.014). In multivariate analyses the lipid and nucleotide metabolic pathways were both associated with the presence of CAD, after adjustment for traditional risk factors. We report novel associations between CAD plaque phenotypes and four metabolites previously associated with CAD. We also identified two metabolic pathways strongly associated with CAD, independent of traditional risk factors. These pathways warrant further investigation at both a biomarker and mechanistic level.
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Affiliation(s)
- Stephen T. Vernon
- Cardiothoracic and Vascular Health, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (S.T.V.); (O.T.); (K.A.K.); (J.P.); (T.H.)
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Owen Tang
- Cardiothoracic and Vascular Health, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (S.T.V.); (O.T.); (K.A.K.); (J.P.); (T.H.)
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
| | - Taiyun Kim
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW 2006, Australia
- Computational Systems Biology Group, Children’s Medical Research Institute, Westmead, NSW 2145, Australia
| | - Adam S. Chan
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW 2006, Australia
| | - Katharine A. Kott
- Cardiothoracic and Vascular Health, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (S.T.V.); (O.T.); (K.A.K.); (J.P.); (T.H.)
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - John Park
- Cardiothoracic and Vascular Health, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (S.T.V.); (O.T.); (K.A.K.); (J.P.); (T.H.)
| | - Thomas Hansen
- Cardiothoracic and Vascular Health, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (S.T.V.); (O.T.); (K.A.K.); (J.P.); (T.H.)
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Yen C. Koay
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Heart Research Institute, The University of Sydney, Sydney, NSW 2042, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - John F. O’Sullivan
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Heart Research Institute, The University of Sydney, Sydney, NSW 2042, Australia
| | - Jean Y. Yang
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
- School of Mathematics and Statistics, University of Sydney, Sydney, NSW 2006, Australia
| | - Gemma A. Figtree
- Cardiothoracic and Vascular Health, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW 2065, Australia; (S.T.V.); (O.T.); (K.A.K.); (J.P.); (T.H.)
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia; (T.K.); (A.S.C.); (Y.C.K.); (J.F.O.); (J.Y.Y.)
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Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci 2020; 21:ijms21082992. [PMID: 32340284 PMCID: PMC7216001 DOI: 10.3390/ijms21082992] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.
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Kott KA, Vernon ST, Hansen T, Yu C, Bubb KJ, Coffey S, Sullivan D, Yang J, O'Sullivan J, Chow C, Patel S, Chong J, Celermajer DS, Kritharides L, Grieve SM, Figtree GA. Biobanking for discovery of novel cardiovascular biomarkers using imaging-quantified disease burden: protocol for the longitudinal, prospective, BioHEART-CT cohort study. BMJ Open 2019; 9:e028649. [PMID: 31537558 PMCID: PMC6756427 DOI: 10.1136/bmjopen-2018-028649] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) persists as a major cause of morbidity and mortality worldwide despite intensive identification and treatment of traditional risk factors. Data emerging over the past decade show a quarter of patients have disease in the absence of any known risk factor, and half have only one risk factor. Improvements in quantification and characterisation of coronary atherosclerosis by CT coronary angiography (CTCA) can provide quantitative measures of subclinical atherosclerosis-enhancing the power of unbiased 'omics' studies to unravel the missing biology of personal susceptibility, identify new biomarkers for early diagnosis and to suggest new targeted therapeutics. METHODS AND ANALYSIS BioHEART-CT is a longitudinal, prospective cohort study, aiming to recruit 5000 adult patients undergoing clinically indicated CTCA. After informed consent, patient data, blood samples and CTCA imaging data are recorded. Follow-up for all patients is conducted 1 month after recruitment, and then annually for the life of the study. CTCA data provide volumetric quantification of total calcified and non-calcified plaque, which will be assessed using established and novel scoring systems. Comprehensive molecular phenotyping will be performed using state-of-the-art genomics, metabolomics, proteomics and immunophenotyping. Complex network and machine learning approaches will be applied to biological and clinical datasets to identify novel pathophysiological pathways and to prioritise new biomarkers. Discovery analysis will be performed in the first 1000 patients of BioHEART-CT, with validation analysis in the following 4000 patients. Outcome data will be used to build improved risk models for CAD. ETHICS AND DISSEMINATION The study protocol has been approved by the human research ethics committee of North Shore Local Health District in Sydney, Australia. All findings will be published in peer-reviewed journals or at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12618001322224.
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Affiliation(s)
- Katharine A Kott
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen T Vernon
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Hansen
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christine Yu
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Kristen J Bubb
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sean Coffey
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - David Sullivan
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Biochemistry, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jean Yang
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Mathematics and Statistics, University of Sydney, Sydney, New South Wales, Australia
| | - John O'Sullivan
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- The Heart Research Institute, Sydney, New South Wales, Australia
| | - Clara Chow
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sanjay Patel
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- The Heart Research Institute, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - James Chong
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The Heart Research Institute, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Leonard Kritharides
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
- ANZAC Research Institute, Sydney, NSW, Australia
| | - Stuart M Grieve
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- The Heart Research Institute, Sydney, New South Wales, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Gemma A Figtree
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
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12
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Mander GTW, Dobeli K, Steffensen C, Munn Z. Diagnostic accuracy of computed tomography coronary angiography utilizing recent advances in technology in patients with high heart rates: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1312-1318. [PMID: 30520771 DOI: 10.11124/jbisrir-2017-003883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The objective of this review is to determine the diagnostic accuracy of computed tomography coronary angiography (CTCA) using recent scan technologies for detecting coronary artery disease (CAD) in adults with high heart rates. INTRODUCTION Invasive coronary angiography is the gold standard for detecting significant CAD, but it is costly and carries risks of complications. Computed tomography coronary angiography has a high sensitivity for diagnosing CAD, although image quality may be affected by elevated heart rates. Recent technological advances in scanner design may increase the diagnostic accuracy of CTCA. INCLUSION CRITERIA This review will consider diagnostic test accuracy studies that include adults 18 years and older with a heart rate greater than 65 beats per minute who have undergone CTCA to diagnose CAD (greater than 50% stenosis). Eligible studies will compare invasive coronary angiography with computed tomography scanner technologies that use either single- or dual-source scanner configuration in prospective electrocardiogram scan acquisition mode, and with a total scanner coverage equal to or greater than 128 detector-rows. Studies published in English from 2007 will be considered. METHODS PubMed, Embase, CINAHL and Scopus will be searched, along with Google Scholar, the NIHR-HTA register, computed tomography vendors and conference abstracts. Screening of potential titles and abstracts, retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Meta-analyses will be performed, if possible, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.
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Affiliation(s)
- Gordon T W Mander
- Department of Medical Imaging, Toowoomba Hospital, Darling Downs Hospital and Health Service, Toowoomba, Australia
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Karen Dobeli
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Caitlin Steffensen
- Philips Australia and New Zealand, Murarrie, Brisbane, Australia
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Zachary Munn
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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The Value of 16-cm Wide-Detector Computed Tomography in Coronary Computed Tomography Angiography for Patients With High Heart Rate Variability. J Comput Assist Tomogr 2018; 42:906-911. [PMID: 30119063 DOI: 10.1097/rct.0000000000000787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate radiation dose and image quality of coronary computed tomography (CT) angiography (CCTA) for patients with high heart rate variability (HRv) using 16-cm wide-detector CT scanner. METHODS One hundred sixty-six patients with uncontrolled heart rate underwent CCTA on a 16-cm wide-detector CT system and were divided into 2 groups based on their HRv for analysis: group A (n = 95, HRv ≤10 beats/min [bpm]) and group B (n = 71, HRv >10 bpm). Images in both groups were reconstructed with motion correction algorithm. Subjective and objective image qualities were analyzed. RESULTS There were no significant differences in age, body mass index, and heart rate (68.1 ± 11.4 vs 67.6 ± 12.3 bpm) between the 2 groups (P > 0.05). However, group B had significantly higher HRv than group A (33.5 ± 24.4 vs 7.8 ± 1.2 bpm, P < 0.001). All images were acceptable for clinical diagnosis. Compared with group A, image quality scores in group B decreased slightly (4.1 ± 0.5 vs 4.0 ± 0.6). However, the difference was not statistically significant. The mean effective doses were both relatively low at 2.2 ± 1.1 mSv in group A and 2.6 ± 1.4 mSv in group B. CONCLUSIONS Single-heartbeat free-breathing CCTA can be performed for patients with high HRv using 16-cm wide-detector CT scanner to achieve diagnostic image quality with low radiation dose.
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Higashigaito K, Hinzpeter R, Baumueller S, Benz D, Manka R, Keller DI, Alkadhi H, Morsbach F. Chest pain CT in the emergency department: Watch out for the myocardium. Eur J Radiol Open 2018; 5:202-208. [PMID: 30456219 PMCID: PMC6232643 DOI: 10.1016/j.ejro.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/31/2022] Open
Abstract
Hypodense myocardium (HM) can be observed often in chest pain CT examinations of patients presenting to the emergency department with chest pain. There is benefit when the myocardium is also analyzed for the presence of HM, even when the heart and coronary arteries were not specifically asked-for. Sensitivity, specificity, PPV and NPV for the detection of acute myocardial infarction by assessing HM was 52%, 100%, 100% and 95% respectively. Assessment of hypodense myocardium may increase the diagnostic confidence in ambiguous coronary findings in chest pain CT.
Rationale and Objectives To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CTcoronary, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CTw/o coronary, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results HM was identified in 27/300 patients (9%): 12/179 in chest-pain CTw/o coronary (7%) and 15/121 in chest-pain CTcoronary (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients’ history. Chest-pain CTw/o coronary identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI. Conclusion HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CTw/o coronary when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.
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Key Words
- AAC/AHA, American College of Cardiology / American Heart Association
- AAS, acute aortic syndrome
- ACS, acute coronary syndrome
- Acute chest pain
- BPM, beats per minute
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CX, circumflex artery
- Cardiac
- Computed tomography
- ECG, electrocardiography
- ED, emergency department
- Emergency department
- HU, hounsfield unit
- ICC, intraclass correlation coefficients
- LAD, left anterior descending artery
- MH, hypodense myocardium
- MI, myocardial infarction
- NPV, negative predictive value
- NSTEMI, non-ST elevation myocardial infarction
- PE, pulmonary embolism
- PPV, positive predictive value
- RCA, right coronary artery
- ROI, region of interest
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Affiliation(s)
- Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephan Baumueller
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - David Benz
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3762305. [PMID: 30533431 PMCID: PMC6250018 DOI: 10.1155/2018/3762305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/01/2018] [Accepted: 10/10/2018] [Indexed: 01/11/2023]
Abstract
Stable chest pain is a common clinical presentation that often requires further investigation using noninvasive or invasive testing, resulting in a resource-consuming problem worldwide. At onset of 2016, the National Institute for Health and Care Excellence (NICE) published an update on its guideline on chest pain. Three key changes to the 2010 version were provided by the new NICE guideline. First, the new guideline recommends that the previously proposed pretest probability risk score should no longer be used. Second, they also recommend that a calcium score of zero should no longer be used to rule out coronary artery disease (CAD) in patients with low pretest probability. Third, the new guideline recommends that all patients with new onset chest pain should be investigated with a coronary computed tomographic angiography (CTA) as a first-line investigation. However, in real world the impact of implementation of CTA for the evaluation of new onset chest pain remains to be evaluated, especially regarding its cost effectiveness. The aim of the present report was to discuss the results of the studies supporting new NICE guideline and its comparison with European and US guidelines.
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Radiation dose-reduction strategies in thoracic CT. Clin Radiol 2017; 72:407-420. [DOI: 10.1016/j.crad.2016.11.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 01/08/2023]
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The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017; 10:15. [PMID: 28446943 PMCID: PMC5368205 DOI: 10.1007/s12410-017-9412-6] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose of Review Cost-effective care pathways are integral to delivering sustainable healthcare programmes. Due to the overestimation of coronary artery disease using traditional risk tables, non-invasive testing has been utilised to improve risk stratification and initiate appropriate management to reduce the dependence on invasive investigations. In line with recent technological improvements, cardiac CT is a modality that offers a detailed anatomical assessment of coronary artery disease comparable to invasive coronary angiography. Recent Findings The recent publication of the National Institute for Health and Care Excellences (NICE) Clinical Guideline 95 update assesses the performance and cost utility of different non-invasive imaging strategies in patients presenting with suspected anginal chest pain. The low cost and high sensitivity of cardiac CT makes it the non-invasive test of choice in the evaluation of stable angina. This has now been ratified in national guidelines with NICE recommending cardiac CT as the first-line investigation for all patients presenting with chest pain due to suspected coronary artery disease. Additionally, randomised controlled trials have demonstrated that cardiac CT improves diagnostic certainty when incorporated into chest pain pathways. Summary NICE recommend cardiac CT as the first-line test for the evaluation of stable coronary artery disease in chest pain pathways.
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Roditi G. Special Issue - Spotlight on Cardiovascular Imaging. Clin Radiol 2016; 71:719-21. [PMID: 27180080 DOI: 10.1016/j.crad.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Affiliation(s)
- G Roditi
- Department of Radiology, University of Glasgow, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK.
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